Report on Workshop Proceedings

Background:
In health care, clinical decisions are mostly based on evidence and research rather than tradition or common sense for many decades. Evidence is fundamental in the clinical practice for Diagnosis, treatment and assessing clinical outcome.

In management practice, it is relatively negligible. Contemporary managers and management educators make limited use of evidence base relevant to effective management practice. But in most of the cases, they got very good system that capture data more systematically and also electronically using well established computer systems in the recent years. But only a small fraction of individuals and organization are using the data generated for finding and using the evidence in their practice. These lead to lack of motivation among people, no space to share their experience, lack of experimentation and innovation, uncertain about quality of data generated, no feedback to the system for continuous improvement and intermittent growth of the organization due to individual specific management practices. It is time for managers to shift their paradigm from tradition and common sense approach to research and use evidence for management practices.

In this context, to promote the culture of using evidence for management practices, the workshop was organized with the objectives

• To orient the importance of data collection
• To promote the culture of evidence based management
• To appreciate the significance of data in taking better decisions
• To orient managers in the process of evidence based management practice

The target audiences were mainly hospital heads, administrators or IT heads from the hospitals that have already been using IT systems or planning to implement in the near future. This is to make sure that the implementation of learning from the workshop could happen much faster.

Supported by:
Intel has been doing a lot of health care initiatives. When we proposed the idea of having this workshop and requested Intel to support this event, they agreed right away. They have also come forward to share the recent developments in IT for health care during the workshop. This report covers the details of the workshop and key discussions during the sessions.

Participants Details:
There were totally 43 participants including 8 from Aravind Eye Hospitals network.

Most of the participants are already having IT & Systems in place.

Faculty Members:
In order to share the real-time experience, all the faculty members were identified from the respective field and have practical experience. As the sessions was designed to discuss the experience of using evidence in non-health care industries, experts from various industries were invited to share their experience. Following faculty members were invited;

	Dr Para Rajasegaram, Former Consultant, WHO, Geneva		Mr D Nagarajan, Consultant, Former Regional Director, Sight Savers International
	Dr Nirmala Murthy, Honorary President-Foundation for Health in Research System, Bangalore		Mr N Krishnanoorthy, President , Dealership Business, TVS & Sons, Madurai
	Mr K Chandrasekar, CEO, Forus Health, Bangalore		Mr Sundaresan Jegadeesan, Sr Manager , Quality & CM, ST Ericcson, Bangalore
	Mr Ravi Sunderrajan, Country Controller, Citrix, Bangalore		Mr K Anand Sudhan, Consultant, SNC Chitrakoot
	Mr Karthikeyan, Executive Housekeeping, Fortune Pandiyan, Madurai

Apart from them, senior management and medical officers of Aravind Eye Care System, presented their experience on how evidence is used for managing in Aravind.


The sessions were designed to address key challenges in eye care organizations. Depends upon the details and applications, times were allotted for each sessions. Following key areas were covered during the workshop;

Day-1: (October 4th ,2010)

• Performance and Productivity
• Quality, Outcomes & Patient Satisfaction
• Supply Chain & Equipment Management

Day02 (October 5th,2010)

• Managing Finance with Information for Cost Controlling and Projection
• Evidence for Human Resource Management
• Creating the Culture of Evidence Based Management Practices
• Role of Information Technology

Each session were taken through the following process; Information could help at levels in the organization. Also, if the problems are addressed at the lower level itself, we will have better outcome at the top level. For example, if we want to monitor the waiting time of patients, we have to make sure that the operational staffs have access to list of patients waiting for more than one hour or so, to attend and give priority to them. This will help the organization to accomplish the overall objective of reducing the waiting time. Hence, we covered information needs at all levels.

Day I - October 4, 2010
The workshop started with the prayer song.

Welcome Address: The welcome address was delivered by Mr. Nagarajan the former Regional Director, South Asia for Sight Savers International, warmly welcomed all participants and shared some of his own experience when he was working as an engineer in railways, also mentioned how generating reports is changing from 1960s to now.

Special address: The special address was delivered by Dr. Nirmala Murthy a Doctor of Science from the Harvard University. She started by sharing her own experiences on primary health care and said what professionals do with data

generally and what are the drawbacks of not using it properly, the drawbacks she listed was like in making decisions, manipulation of data etc. and she also stressed on the importance of capturing data.

Keynote address: The keynote address was delivered by Mr.R.D.Thulasiraj, Executive Director,LAICO. He started the address by stressing the importance of evidence based management practices. also mentioned myths and realities of the hospitals using various real-time examples.

The inaugural session was ended with the program overview and presentation on other logistics. After the break we started the module on productivity and performance.

Mr.N.Krishnamoorthy President of T V Sundaram Iyengar & Sons limited, explained the TVS Model on how they enhance productivity and performance by Showing lot of real time data, and narrated on what are all the problems they had particularly on time management to deliver the vehicle after service and what were all the decisions taken by them at that point of time and how useful it was by identifying some innovative methods and finally he also shared how they effectively used their manpower and time after taking decisions based on their reports.

Followed by this, Dr. Krishnadas CMO, Aravind Eye Hospital, Madurai spoke on Aravind Experience on using evidence to enhancing their productivity and performance by showing real time data, he mainly stressed on the problems during peak hours due to too much of patient load. And what they did to solve it based on the data collected through clinical management system software.

SNC,Chitrakoot, MP has unique experience in patients load and demand generation. We requested Mr Anand Sudan, to share their experience on using evidence for managing patients load and demand pattern.

After the presentations, panel discussion was organized with all the presenters and participants from other hospitals. The session was moderated by Mr RD Thulasiraj.

The floor was initially opened for the participants to raise the questions to the presenters. There were a lot of questions for clarifications and further details which were directed to concerned presenters and then discussed to bring out other interesting points related to productivity and evidence.

The session ended with lunch break.

Another key area is application of evidence for clinical quality and patient satisfaction. The session was started with the presentation from Mr Sundaresan Jegadeesan, Senior Manager, Quality and Configuration Management.

He shared his own experience and Started off his presentation with the evidence on lack of quality checks by quoting the examples of penguin, Toyota, Sony. Emphasized on the importance of planning, earned value based management, milestone trend analysis, tracking and reporting data and he also listed down some tips on how to set up control structures.

Followed by that, Dr. Haripriya presented on enhancing quality eye care and patient satisfaction by dividing quality into clinical and non clinical. Clinical was further divided into surgical care and patient compliance. She explained the details captured at each stage and how it is quality checked and then complied and used to enhance the quality of the care. Also, she shared how non-clinical care, ie patient satisfaction survey is done and how the findings are used to improve our service delivery.

One of the key challenges in generating evidence is lack of data availability or lack of quality of the data available. Dr. Nirmala Murthy made a presentation on indicators and challenges in data collection. She divided quality into technical and perceived quality, technical quality is entirely based on clinical research i.e. Vision restoration, follow up and perceived quality is based on access, courtesy, reliability, empathy etc.. She also shared the details of an exit interview of a primary health care and explained the improvements made after that. And the huge perception difference between doctors and patients.

Followed by the presentations, panel discussion was held on : Committing to measure quality and Patient satisfaction - Challenges, Opportunities and Benefits. Moderated by Dr Nirmala Murthy.

The session ended with tea-break at 4pm.

Still many hospitals do not have proper system for inventory management and maintaining equipment and facilities. This session was designed to highlight the importance of proper inventory management to reduce cost of services and how to maintain the facilities. Mr.R.D.Sriram, Director of operations, Aurolab, Madurai made a presentation on inventory management, firstly, emphasized the need on inventory management and the recent trends which are being followed such as JUST IN TIME and he also stressed on hospital perspective and provided some useful tips for that. Also stressed on the Dos and Don'ts on contracts

Followed by his presentation, Mr. Muthusamy manager-stores Aravind eye hospital Madurai, made a brief presentation on how reports are being generated for inventory management in Aravind eye hospitals and its advantages.

Prof.V.Srinivasan consultant, Aravind eye hospital made a brief presentation on how equipments are being maintained and specific decisions like replacement etc., are taken using evidence in Aravind eye hospitals.

Mr. Karthikeyan, Executive-Housekeeping from fortune Pandian hotel made a presentation on housekeeping management and the measures taken by them to satisfy the customers to the maximum, he also showed so many parameters and check lists which are being followed in fortune Pandian hotel. Day-1 is concluded with the announcement of Special Dinner at Hotel Pandiyan, sponsored by Intel. All the participants were requested to assemble around 7.00pm at the hotel.

Day-II: October 5, 2010
The day started with the module on Finance.

Mr.RaviSunderRajan is a Chartered Accountant & Cost Accountant with over 11 years of cross-cultural experience in the areas of Strategic and Financial Analysis is currently working as a country controller in CITRIX. first made a self introduction of himself and his concern CITRIX and stressed on so many things such as techniques to gather evidence and also urged all participants to always at least look 5 years down the line and get prepared for technological changes, government's policy changes, protectionism and he also mentione d on things which should not be done. His presentation gave a overall idea of financial management and what information would be useful to take decision and managing.

Followed by that, Mr.G.Srinivasan President GOVEL Trust and Director-Finance, AECS made presentation on what they practice in Aravind eye hospital by showing real time data such as the proportion of paying, camp, free patients and how they managed to change things when things were going other way and showed the analysis made in their hospital like income and expenditure analysis, revenue per patient analysis etc

Panel Discussion: Ensuring the appropriateness and accuracy of financial transaction with evidence - Challenges, Opportunites and Benefits.

After the presentation, panel discussion was held to bring out more details about the financial management aspects. There were a lot of questions from the participants both in general about financial management as well as specific questions about how to use the information. The members discussed about the importance of budgeting as most of the health/eye care industries are still not following the budgeting. Mr Ravi Sunderrajan explained the importance of budgeting etc.

The session was moderated by Mr RD Thulasiraj.

This module was originally proposed at the end of the workshop, but rescheduled due to resource person availability.

The session was moderated by Dr Nirmala Murthy who started with the presentation on creating the culture of evidence based management practices. She explained what is EBM, which combination makes EBM? (Operations Research, management science), what are all things that facilitate EBM, strategies to be worked out to make EBM work.

Followed by the presentation, there was a panel discussion where the senior leaders and heads of the hospital participated.

The discussions were mainly on obstacles to practicing evidence based management, who should initiate, what are the processes involved etc. The main challenges discussed were lack of documentation, no system to review and practice, using experience than data etc.

Useful tips were shared by participants, panel members and moderators to overcome the challenges for practicing evidence based management. The session ended for lunch break.

After the lunch break, the session was started with a module on Human resource management.

Mr. Chandrasekhar from FORUS HEALTH made a presentation on evidence based management on human resources based on 4 different case studies (qualitative and quantitative).In this he detailed everything on how they went about in these four different types of surveys and the respondents mentality on those surveys. He focused mainly about collecting data from employees and using them to implement HR policies. Followed by that Dr. Usha Kim presented on human resource management, how it is being practiced in Aravind particularly (MLOPS cadre) like how to do manpower planning, analysis, attrition rate analysis, how they train MLOPS, assessments like skill evaluation test, attendance and how they use information to develop the manpower and focusing on specific employee etc. She also shared retention policies, performance appraisal, leave details and day to day activities.

presentation by both the faculty members, panel discussions were continued. The session was moderated by Dr Usha Kim and panel members were heads of hospitals from Vivekananda Mission Hospital, Chaitanyapur, West Bengal and RR Lions Hospital, Palakol. The session continued for 45 minutes. There were a lot of discussion how to employ some of the techniques presented by Mr KC and also discussion on getting and retaining manpower in general.

Information Technology is playing key role to capture, process, analyze and presentation of information which is key for management practices. We have included two short presentations on role of information technology for evidence based management practices.

Mr Nishanth,Cannoi, Bangalore gave the presentation of the technologies available for health care management. He demonstrated a specific system that is designed for health care professionals.

Mr. Ganesh babu presented on how to use IT in evidence based management resources by showing the software's being used in Aravind and some of the technologies for improving the way of accessing the information, what are the precautions one should take when we develop central database etc. He also shared some of the interesting tools that would help for strengthening information system like EyeQ-Benchmarking tool, GIS etc.

After this final presentation on information technology, Dr Para Rajasekaram gave the Valedictory address and stressed the importance of this workshop and how to take this forward etc. And he urged the participants to be lifelong learners and keep on attending this sort of workshop at regular intervals

The vote of thanks was delivered by Mr. Ganesh babu in that he thanked all the participants and Mr.Thulasiraj for mentoring, Intel for supporting and the entire team who worked hard and supported to conduct this workshop successfully.